gms | German Medical Science

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation, Annual Assembly of the German and the Austrian Society of Physical Medicine and Rehabilitation

Gliederung

Objective: To explore the effects of manual mobilisation on the thoracic spine mobility, respiratory function and disease activity in patients with ankylosing spondylitis (AS).

Material/Methods: Two groups, each consisting of 12 patients, were treated with physiotherapy during inpatient therapy. One group was also treated with manual mobilisation of the thoracic spine for an average of 6 sessions, whereas the other group only received conventional physiotherapy. The primary outcome parameter was the mobility of the thoracic spine represented by the Ott’s sign. The secondary outcome parameters were pain (VAS), respiratory function (differences of chest expansion and inspiratory vital capacity = IVC), disease activity (BASDAI), function index (BASFI), and patients global score (BAS-G).

Results: Mobility of the thoracic spine (Ott’s sign) increased significantly within the group of manually mobilized patients compared to baseline (hospital admission) at each of the follow-up visits (p_discharge=0.002, p_1month=0.002, p _3months=0.004). No significant impact on thoracic spine mobility could be noted in the control group. Comparing both groups, manually mobilised patients had significantly improved mobility at the time of discharge from the hospital (p=0.002) as well as 1 month later (p=0.009). No difference could be shown after 3 months. An impact on reducing pain (VAS) was not achieved. Merely the group treated with manual mobilisation showed a tendency to pain reduction compared to baseline (p_discharge=0.006, p_1month=0.005, p _3months=0.013). Parameters of the respiratory function test increased during therapy with manual mobilisation. Compared to baseline chest expansion improved at all follow-up visits (p_discharge=0.001, p_1month=0.026, p _3months=0.005). The therapy also had a positive impact on the IVC at the time of discharge (p=0.003) and after 3 months (p=0.008). Regarding the scores (BASDAI, BASFI, BAS-G), a significant decrease was detected, thus reflecting a general improvement of the manually treated patients in terms of disease activity and function. Overall, the observed effects on most outcome parameters lasted until the follow-up visit at 1 month after discharge but were observed to 3 months later.

Conclusion: The results show that physiotherapy including manual mobilisation of the thoracic spine promotes mobility, improves respiratory function and has a positive influence on disease activity and physical function. Therefore, manual mobilisation of the spine should be included in the physical therapy concept of patients with AS. Since the effects appear to last for approximately 3 months, manual mobilisation should be repeated on a regular basis for optimal long-term outcome.